Trial design: congestive heart failureEndomyocardial biopsy plays a role in diagnosing patients with unexplained cardiomyopathy
Section snippets
Selection of patients
The study group consisted of 1230 patients who underwent EMBx for evaluation of unexplained cardiomyopathy at The Johns Hopkins Hospital between December 1982 and December 1997. Most of these patients were referred for biopsy after initial evaluation in a physician's office or in another hospital. Therefore, some common causes of heart failure that are more easily identifiable (ie, ischemic heart disease, hypertension, etc) are underrepresented in this patient group. Since we currently do not
Role of EMBx in diagnosing patients with unexplained cardiomyopathy
A specific final diagnosis was identified in 316 (37%) of 845 patients with initially unexplained cardiomyopathy. Myocarditis was the most common final diagnosis in this population, followed by ischemic heart disease and infiltrative disorders. The remaining 529 (63%) patients who did not have a clear explanation for their cardiomyopathy were classified as having idiopathic cardiomyopathy (Table I, second column).
In 264 (31%) of the 845 patients, the final diagnosis differed from the initial
Discussion
Assessment of the cause of cardiomyopathy can usually be made based on the clinical presentation, history, physical examination, and selected laboratory studies. However, there are certain patients whose diagnoses remain unclear despite extensive initial evaluations. These patients may be referred to a tertiary care center to undergo EMBx. Since its introduction into clinical practice in 1963,9 EMBx has gradually become an accepted diagnostic intervention. It is mainly utilized for monitoring
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